Electronic Visit Verification General Stakeholder Meeting

May 19, 2020

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Our Mission

Improving health care access and outcomes for the people we serve

while demonstrating sound stewardship of financial resources

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WELCOME Stakeholders

• HCPF Introductions

• House Keeping

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Meeting Purpose

The purpose of this meeting is to engage providers,members, and other stakeholders as the Departmentworks to implement EVV for community based servicesoffered through both the State Plan and Waivers.

And specifically to:

• Review EVV, the legislative mandate, and the scope of implementation

• Discuss EVV Project Updates

• Provide a platform to gather stakeholder feedback

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Meeting Guidelines

We ask that you:

• Mind E-manners

• Identify yourself when speaking

• Share the air

• Listen for understanding

• Stay solution and scope focused5

Agenda

Introductions

Brief Overview of EVV

Implementation Timeline

Code of Regulation Update

Live-in Caregiver Exemption

Support Resources Overview

Sandata Call Center Report

Department Data Analytics

Open Forum

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Overview of EVV

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What is EVV?

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• Electronic Visit Verification (EVV) is a technology solution which verifies information through mobile application, telephony, or web-based portal

• EVV is used to ensure that home or community-based services are delivered to people needing those services by documenting the precise time service begins and ends

• Section 12006 of the 21st Century Cures Act requires all state Medicaid agencies implement an EVV solution

• States that do not implement EVV will incur a reduction of Federal funding

• The Department will implement and mandate EVV for all Colorado required services on August 3, 2020.

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What must EVV Capture?

TYPE OF SERVICE PERFORMED

INDIVIDUAL RECEIVING THE

SERVICE

DATE OF THE SERVICE

LOCATION OF SERVICE DELIVERY

INDIVIDUAL PROVIDING THE

SERVICE

TIME THE SERVICE BEGINS AND ENDS

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• Personal Care • Pediatric Personal Care• Home Health: RN, LPN, CNA, PT, OT, SLP• Private Duty Nursing• Hospice • Homemaker• Respite (provided in the home or community)• Consumer Directed Attendant Support Services

(CDASS)• In-Home Support Services (IHSS)

• Independent Living Skills Training (ILST)• Life Skills Training • Physical Therapy (provided in the home) • Occupational Therapy (provided in the home)• Speech Therapy (provided in the home)• Behavioral Therapies (provided in the home or

community)• Pediatric Behavioral Health • Youth Day • Durable Medical Equipment (select services)

Which Services Require EVV?*

*Subject to change10

Behavioral Therapies

Consumer Directed Attendant Support

Services

Consumer Directed Attendant Support

Services – SLS Health Maintenance

Durable Medical Equipment

Home Health –Certified Nurse Aide

Home Health –Nursing

Home Health –Occupational

TherapyHome Health –

Physical TherapyHome Health –

Speech/Language Therapy

Homemaker Hospice - In Home Hospice - Inpatient

Independent Living Skills Training

and Life Skills Training

In-Home Support Services

Occupational Therapy

Pediatric Behavioral Therapies

Pediatric Personal Care Personal Care

Physical Therapy Private Duty Nursing

Respite and Youth Day Speech Therapy

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Service Types Groupings

Service Location

• EVV services happen in the home and in the community.

• EVV does not disrupt this flexibility of service location.

• Facility-based services are exempt from EVV unless otherwise noted.

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State EVV Model: Hybrid

Colorado selected a vendor that will provide EVV solutions, while also allowing providers to use alternative/existing EVV systems if they meet state specifications:

Providers choosing to use an alternate vendor must ensure that their system is configured to Colorado EVV rules and requirements.

Provider Choice Systems must connect to the Data Aggregator

Training is required for State EVV Solution and Provider Choice EVV

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State EVV Solution Technologies

Mobile Application Telephony

Provider Web Portal

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Questions

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EVV Implementation Timeline

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• 9/18/19: Good Faith Effort Exemption request approved by CMS.

• 10/1/2019: State EVV Solution and Data Aggregator went live.

• 10/1/2019 – 8/2/2020: Soft-Launch.

• 8/3/2020: EVV mandate, providers must use EVV.

• 1/1/2021: Prepayment claims review, claims will deny without corresponding EVV.

Colorado EVV Implementation Timeline

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• The State EVV Solution and Data Aggregator are now live and available for use.

• Providers may begin to collect EVV data and transmit to the Department.

• Opportunity to familiarize providers with EVV prior to claims integration. Claims will continue to pay and EVV errors will appear on Remittance Advice (EOB 3054).

• Opportunity for caregivers to practice EVV collection and for members to become accustomed to EVV.

• Help the Department identify and develop supplemental training materials.

• The Department strongly encourages providers to use EVV during the Soft-Launch

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Soft-Launch Review

• The EVV rule completed initial read on May 8, 2020

• The Department is updating the rule to accommodate stakeholder feedback

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Medical Services Board Update

First Reading: 5/8/2020

Second Reading: 6/12/2020

Mandate Effective: 8/3/2020

Live-in Caregiver Exemption

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• Process for Live-in Caregiver Exemption finalized

• Live-in Caregiver Attestation Form finalized

• Memo Series Released: HCPF OM 20-051

• Services eligible for Live-in Caregiver Exemption finalized

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Live-in Caregiver Exemption

Live-in Caregiver means a caregiver who permanently or for an extended period of time resides in the same residence as the Medicaid member receiving services. Live-in caregiver status is determined by meeting requirements established by the U.S. Department of Labor, Internal Revenue Service, or Department-approved extenuating circumstances. Documentation of live-in caregiver status must be collected and maintained by the Provider.

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Live-in Caregivers Definition

EVV Type of Service Live-in Caregiver

Behavioral Therapies Allowed Consumer Directed Attendant Support Services (CDASS) AllowedDurable Medical Equipment Ineligible Home Health AllowedHomemaker Allowed Hospice Allowed Independent Living Skills Training (ILST) and Life Skills Training (LST) Allowed

In-Home Support Services (IHSS) Allowed Occupational Therapy Ineligible Pediatric Behavioral Therapies Ineligible Pediatric Personal Care Allowed Personal Care Allowed Physical Therapy Ineligible Private Duty Nursing Allowed Respite and Youth Day Allowed Speech Therapy Ineligible

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Services Permitted to Utilize Live-in Exemption

• EVV services appropriate for Live-in Caregiver Exemption may utilize exemption, at provider discretion.

• EVV services that require uninterrupted delivery are ineligible for live-in caregiver exemption.

1) Member and Caregiver decide if they would like to apply for the Live-in Caregiver Exemption from EVV.

2) Member or Caregiver review service list eligible for Exemption.

3) Member or Caregiver outreach Provider Agency or FMS Vendor to determine if an Exemption is permitted by the Provider Agency or FMS vendor.

4) If eligible, Member and/or Caregiver fill out Live-in Caregiver Attestation Form and collect supporting documentation.

5) Email EVV@state.co.us if Extenuating Circumstance Determination is necessary.

6) Supply completed form and supporting documentation to Provider Agency or FMS Vendor.

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Live-in Caregiver Process

7) Provider Agency reviews, attests to accuracy of information, and approves – OR –FMS Vendor reviews that required documentation is present and confirms receipt.

8) Once Exemption paperwork is submitted and approved, the Caregiver no longer needs to complete EVV when providing services to the specific Member.

9) Provider Agencies or FMS Vendors bill according to Exemption policy.

10) Provider Agency or FMS Vendor maintain exemption records and ensure they are updated annually. Records may be audited by the Department at without notice.

11) If at any time the Member and Caregiver no longer meet requirements of the Exemption, EVV must be collected.

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Live-in Caregiver Process Cont.

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Live-in Caregiver Attestation From

Online Review

Questions &

Answers

• Determine if Provider Agency or FMS Vendor will utilize the Live-in Caregiver Exemption from EVV

• Maintain Live-in Caregiver records Live-in Caregiver Attestation Form

Supporting documentation

• Follow live-in caregiver billing rules27

Live-in Caregiver ExemptionBilling Provider Responsibilities

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Live-in Caregiver Billing Instructions • Claims billed using the CMS 1500 billing methodology:

• Place of Service 99 must be designated for all lines where a Live-in Caregiver has delivered the service.

• Claims billed using the UB-04 billing methodology:• Condition Code 23 must be designated for all lines where a Live-in Caregiver

has delivered the service. • Each claim line must appropriately indicate if the service was provided by a Live-in

Caregiver.• If the same service is provided by both a Live-in Caregiver and a non-Live-in

Caregiver, the units billed to each should be billed on separate claim lines and indicated correctly.

• What evidence documents should be used for a minor?

• Who signs under “Member or Authorized Representative”?

• What are the differences between Part A and Part B?

• What if I use Place of Service 99 for a different purpose?

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Live-in Caregiver Exemption Inbox Questions

Project Updates

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EVV Inbox

EVV@state.co.us

DXC (Billing)

Help Desk

Phone: 1-844-235-2387

EVV Help Desk

Phone: 1-855-871-8780

Email: COCustomerCare

@sandata.com

Provider Choice

Interface

Phone: 1-844-289-4246

Email: COAltEVV

@sandata.com

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EVV Support Pathways

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EVV Support PathwaysPathway Method Purpose Prepare Before

ContactingExpected Initial Response Time

EVV Help Desk

1-855-871-8780

COCustomerCare@sandata.com

Using State EVV Solution, interfacing Provider Choice Systems, Sandata trainings, EVV accounts

Nothing needed

Phone: As soon as connected

Email: within two business days

DXC (Billing) Help Desk 1-844-235-2387 Provider billing or claims

processing questions Nothing needed As soon as connected

EVV Inbox EVV@state.co.us

Dept. approval of Live-in Caregiver exemption, Policy and Program answers, Escalations from other support methods

Live-in Caregiver Documentation for review, Help Desk documentation (Call number, who you talked to, etc.)

Within a week

Sandata Call Center Report

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Sandata Call Center

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Phone855-871-8780

EmailCOCustomerCare@Sandata.com

May-20

Total Incoming Calls

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Percent of Calls Captured

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Call Times: What To Expect

Wait Time for a Call Representative Time With a Call Representative

20.89 Seconds 10.58 Minutes

EVV Department Analytics

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Oct 1, 19 Nov 1, 19 Dec 1, 19 Jan 1, 20 Feb 1, 20 Mar 1, 20 Apr 1, 20 May 1, 20 Jun 1, 20 Jul 1, 20 Aug 1, 20

Day of Claim Paid Date

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Perc

Expected Percent

72.73%

Cumulative Percent

11.74%

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Expected and Cumulative Percent of Providers Who Utilized an EVV System

Cumulative Percent

11.74%

Expected Percent

72.73%

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Most Common Visit ExceptionsLocation Required

21.66%

Unmatched Client ID/Phone20.44%

Visits Without Any Calls20.17%

Visits Without Out Calls14.25%

Missing Service12.55%

Unkown Employees5.72%

Visits Without In Calls5.21%

Visit exceptions are error flags thrown on a visit that is

missing one or more required points of data.

Questions

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Contact Information

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Lana EggersEVV@state.co.us

www.colorado.gov/hcpf/evv

Thank you!

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